US20100198311A1 - System and method for cardiac lead switching - Google Patents
System and method for cardiac lead switching Download PDFInfo
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- US20100198311A1 US20100198311A1 US12/363,321 US36332109A US2010198311A1 US 20100198311 A1 US20100198311 A1 US 20100198311A1 US 36332109 A US36332109 A US 36332109A US 2010198311 A1 US2010198311 A1 US 2010198311A1
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
- A61N1/37—Monitoring; Protecting
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/02—Details
- A61N1/04—Electrodes
- A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
- A61N1/056—Transvascular endocardial electrode systems
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A—HUMAN NECESSITIES
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- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
- A61N1/37—Monitoring; Protecting
- A61N1/3718—Monitoring of or protection against external electromagnetic fields or currents
Definitions
- the present disclosure relates to implantable medical devices (IMDs), in particular to a system and method for use of a cardiac lead that includes a switch responsive to an external field, such as that generated during a magnetic resonance imaging (MRI) procedure.
- IMDs implantable medical devices
- MRI magnetic resonance imaging
- the human anatomy includes many types of tissue that can either voluntarily or involuntarily, perform certain functions. However, after disease or injury, certain tissues may no longer operate within general anatomical norms. For example, after disease, injury, age, or combinations thereof, the heart muscle may begin to experience certain failures or deficiencies. Some of these failures or deficiencies can be corrected or treated with implantable medical devices (IMDs). These devices can include implantable pulse generator (IPG) devices, pacemakers, implantable cardioverter-defibrillator (ICD) devices, cardiac resynchronization therapy defibrillator devices, or combinations thereof.
- IPG implantable pulse generator
- ICD implantable cardioverter-defibrillator
- cardiac resynchronization therapy defibrillator devices or combinations thereof.
- One of the main portions of the IMD can include a lead that is directly connected to tissue to be affected by the IMD.
- the lead can include a tip portion that is directly connected to the anatomical tissue, such as a muscle bundle, and a lead body that connects to the device body or therapeutic driving device.
- the device body or case portion can be implanted in a selected portion of the anatomical structure, such as in a chest or abdominal wall, and the lead can be inserted through various venous portions so that the tip portion can be positioned at the selected position near or in the muscle group.
- the IMD generally remains with the patient during the rest of the patient's natural life. To that end, the IMD can be exposed to various environmental factors. For example, the patient may undergo a magnetic resonance imaging (MRI) procedure or other high frequency imaging procedures. In this case, portions of the IMD may act as an antenna and have current and thermal energy induced therein due to the MRI procedure. This induced heat can damage anatomical tissue and cause injury to the patient. Accordingly, reduction or dissipation of the induced current or thermal energy may be useful in certain circumstances.
- MRI magnetic resonance imaging
- An implantable medical device can include implantable pulse generator (IPG) devices, implantable cardioverter-defibrillators (ICD), cardiac resynchronization therapy defibrillator devices, neurostimulators or combinations thereof.
- IPG implantable pulse generator
- ICD implantable cardioverter-defibrillators
- the IMD can be positioned in a selected portion of the anatomical structure, such as a chest wall or abdominal wall, and a lead can be positioned through a vein or transvenously so that a lead tip can be implanted in a portion of the cardiac or heart muscle.
- Various portions of the IMD such as a case or device body, the lead body, or the lead tip, can be formed or augmented to reduce or dissipate heat production due to various external environmental factors.
- a magnetic and/or electric field from a magnetic resonance imager (MRI), diathermy (including shortwave, microwave, ultrasound, or the like) or other energy field producing devices can induce currents in the lead.
- features or portions can be incorporated into the lead body, the lead tip, or the device body to reduce the creation of an induced current, or dissipate or increase the area of dissipation of thermal energy created due to an induced current in the lead.
- the device can include a lead having a body.
- the body of the lead can have at least one conductor to transmit the therapy through the body of the lead.
- the device can further include at least one tip electrode coupled to the body of the lead. The at least one tip electrode can be in electrical communication with the at least one conductor to deliver the therapy to a portion of the anatomical tissue in a first operational state.
- the at least one tip electrode can be selectively decoupled from the at least one conductor to reduce heating in the presence of a magnetic and/or electric field (e.g., from a magnetic resonance imaging (MRI) device) and briefly re-coupled to the at least one conductor to deliver a pacing therapy before being decoupled again.
- a magnetic and/or electric field e.g., from a magnetic resonance imaging (MRI) device
- the device can also include at least one ring electrode fixedly coupled to the body of the lead. The at least one ring electrode can be in electrical communication with the at least one conductor to provide sensing or to deliver the therapy to the anatomical tissue in the first operational state.
- the at least one tip and ring electrodes can be selectively decoupled from their respective conductors to reduce heating in the presence of a magnetic and/or electric field (e.g., from a magnetic resonance imaging (MRI) device) and briefly re-coupled to the conductors to deliver a pacing therapy before being decoupled again.
- a magnetic and/or electric field e.g., from a magnetic resonance imaging (MRI) device
- the lead can switch between the first operational state and the second operational state based on whether an external field is present.
- an implantable medical device operable to generate the therapy for the anatomical tissue.
- the device can include a lead having a proximal end in electrical communication with the therapy device, a distal end and a body.
- the body of the lead can have at least one conductor to carry the therapy through the body of the lead.
- the device can further include at least one tip electrode coupled to the distal end of the lead that can be operable to deliver the therapy to a portion of the anatomical tissue.
- the device can include at least one ring electrode coupled to the lead that can be operable to provide sensing or to deliver the therapy to the anatomical tissue.
- the device can also include a switch that can electrically couple the at least one conductor to the at least one tip electrode and/or to the at least one ring electrode.
- the device can include at least one control system that can activate the switch to electrically couple the at least one conductor to the at least one tip electrode (and ring electrode in a bipolar lead) in a first operational state or to selectively electrically decouple the at least one conductor to the at least one ring electrode (and ring electrode in a bipolar lead) in a second operational state in the presence of an external field.
- the tip (or tip and ring) electrode is briefly re-coupled to the conductor(s) to deliver therapy before being decoupled again.
- the method can include providing a lead having at least one conductor passing through the lead, at least one first electrode in electrical communication with the at least one conductor to deliver a therapy to a portion of the anatomical tissue and at least one second electrode in electrical communication with the another conductor for sensing or to deliver a therapy to the anatomical tissue.
- the method can also include determining whether the external field is present and selectively electrically decoupling the at least one first electrode (and/or the at least one second electrode) in the presence of the external field and briefly re-couple the at least one first electrode (and/or the at least one second electrode) with the at least one conductor to deliver the therapy before being decoupled again.
- the method can include electrically re-coupling the at least one first and second electrode with the their respective conductors to deliver the therapy when the external field is no longer present.
- FIG. 1 is a view of an IMD including a lead connected to a device body
- FIG. 2 is a simplified environmental view of the IMD implanted in a patient
- FIG. 3 is a simplified environmental view of an IPG that includes an exemplary cardiac lead system with a switch responsive to an external field, such as that generated during a magnetic resonance imaging (MRI) procedure;
- MRI magnetic resonance imaging
- FIG. 4 is a simplified perspective view of a ring electrode and the switch of the cardiac lead system of FIG. 3 ;
- FIG. 5 is a simplified schematic illustration of the IPG and cardiac lead system of FIG. 3 ;
- FIG. 6 is a dataflow diagram illustrating a control system performed by the IPG.
- FIG. 7 is a flowchart illustrating an exemplary method performed by the IPG.
- the present teachings are directed towards providing a system and method for use of a cardiac lead that includes a switch that is responsive to an external field, such as that generated by a MRI. It should be noted, however, that the present teachings could be applicable to any appropriate procedure in which it is desirable to have a component that is responsive to external fields.
- module refers to an application specific integrated circuit (ASIC), an electronic circuit, a processor (shared, dedicated, or group) and memory that executes one or more software or firmware programs, a combinational logic circuit, and/or other suitable software, firmware programs or components that provide the described functionality. Therefore, it will be understood that the following discussions are not intended to limit the scope of the appended claims.
- ASIC application specific integrated circuit
- an implantable medical device (IMD) 20 which can include implantable pulse generator (IPG) devices, implantable cardioverter-defibrillator (ICD) devices, cardiac resynchronization therapy defibrillator devices, or combinations thereof, is exemplarily illustrated.
- the IMD 20 can include an implantable case or body assembly 22 .
- the implantable case 22 can be formed of appropriate materials and include appropriate features, such as a hermetically sealed body wall 24 .
- the body wall 24 can be made of a substantially inert material or of a conducting material.
- a power device 25 i.e., battery
- the controller assembly 26 can include a circuit board having a processor, memory, transmitter, receiver, and other appropriation portions, further discussed herein.
- the connector body 27 can extend from or be integrated with the case 22 .
- the connector body 27 can include multiple ports 28 that each interconnect with a connector terminal 30 of a lead assembly 32 .
- FIG. 1 illustrates two lead assemblies 32 a , 32 b where each lead assembly 32 a , 32 b includes lead bodies 34 a , 34 b extending from tip electrodes 36 a , 36 b .
- a fixation mechanism can also be included with each lead assembly 32 a , 32 b to affix each tip electrode 36 a , 36 b relative to or in a selected tissue of the patient.
- the fixation mechanism can be near each tip electrode 36 a , 36 b or define a portion of the tip electrode 36 a , 36 b .
- Fixation mechanisms can be any appropriate type, including a grapple mechanism, a helical mechanism, a drug-coated connection mechanism, and other appropriate connection mechanisms.
- each lead body 34 a , 34 b can also be formed in a generally known and selected manner.
- the various conductors and electrical components can be encased in silicone, polyurethane, and other appropriate materials.
- at least one inner electrical conductor (identified as 150 in FIG. 4 ) can extend from each connector terminal 30 to engage each tip electrode 36 a , 36 b (identified as 142 b in FIG. 4 ).
- the inner electrical conductor can be one piece or multiple components that are interconnected.
- more than one inner electrical conductor can be provided, such as one inner electrical conductor for each electrode in each lead assembly 32 a , 32 b .
- the inner electrical conductor can also be cannulated or include a solid or non-cannulated cable.
- the casing material of each lead body 34 a , 34 b can electrically insulate the inner electrical conductor from an external environment.
- the IMD 20 can be implanted in a patient 40 as illustrated in FIG. 2 .
- the IMD 20 can include one or more lead assemblies 32 , such as the first lead assembly 32 a and the second lead assembly 32 b .
- the first lead assembly 32 a and the second lead assembly 32 b can be connected to the connector body 27 .
- the position of lead bodies 34 a , 34 b can depend upon the type of IMD and the malady of the patient 40 .
- the lead assemblies 32 a , 32 b can be positioned transvenously to positions within a heart 42 or on the outside of the heart 42 .
- the IMD 20 can be provided to pace the heart 42 , defibrillate the heart 42 , sense conditions of the heart 42 , etc.
- the IMD 20 can be implanted using known procedures. For example, an incision can be made in a chest wall or an abdomen wall of the patient 40 and the lead assemblies 32 a , 32 b can be passed through selected veins to selected portions of the heart 42 of the patient 40 .
- the case 22 can also be positioned through the incision into a chest wall or abdominal wall of the patient 40 .
- the leads assemblies 32 a , 32 b can be passed through a superior vena cava 44 of the patient 40 .
- the lead tips or tip electrodes 36 a , 36 b can be positioned at various positions in the heart 42 , such as at the ventricles or atriums thereof.
- the position of the lead assemblies 32 a , 32 b and tip electrodes 36 a , 36 b can be selected for pacing, defibrillation, sensing, or other appropriate procedures.
- the specific implantation procedure, position of the tip electrodes 36 a , 36 b , and the like can depend upon the patient 40 , the surgeon performing the procedure, the specifics of the lead assemblies 32 a , 32 b , or other considerations.
- the IMD 20 can include various features or controls to defibrillate or pace the heart 42 .
- the controls can include a processor associated with the controller assembly 26 located within the case 22 .
- the processor can be programmed to control driving a current through the lead bodies 34 a , 34 b to the tip electrodes 36 a , 36 b to defibrillate or pace the heart 42 .
- a programmer or programming system 50 can be provided.
- the programmer 50 can include a telemetry system that is operable to wirelessly transmit a signal to the processor within the case 22 . It will be understood that a wired communication system can also be used.
- an induction system can be used where a coil is positioned near the case 22 and a signal is sent from the programmer 50 via induction.
- the programmer 50 can also receive information from the IMD 20 (e.g. tachycardia rhythms, times and programming settings) to assist in providing an appropriate program for therapy and to determine if the IMD 20 is operating properly.
- the programmer 50 can include any appropriate programming system, including one generally known to those skilled in the art, such as the Medtronic CARELINKTM programmer, sold by Medtronic, Inc. of Minneapolis, Minn.
- the IMD 20 can be formed to counteract or interact with various environmental factors.
- the lead assemblies 32 a , 32 b can include features or portions to re-direct or dissipate thermal energy created by an induced current. Induced currents can be created due to an external field, such as an electromagnetic field acting on the conductors of the lead assemblies 32 a , 32 b.
- the patient 40 which has the implanted IMD 20 may receive a certain therapy or diagnostic technique, such as a magnetic resonance image (MRI) scan.
- MRI magnetic resonance image
- a MRI generally understood by one skilled in the art, uses high frequency radio frequency (RF) pulses and strong magnetic fields to create image data regarding the patient 40 .
- RF radio frequency
- a MRI will have a frequency of about 42 MHz per tesla.
- Many common MRI systems use about 1.5 tesla magnetic fields and have a corresponding RF frequency of about 64 MHz.
- the strong magnetic fields in a MRI can induce aligned spins of sub-atomic particles and the high frequency RF pulses can be used to change the alignment or otherwise affect the sub-atomic particles within the patient 40 .
- the strong magnetic fields and RF pulses may induce currents within the lead assemblies 32 a , 32 b of the IMD 20 .
- the current induced in the lead assemblies 32 a , 32 b may cause certain affects, including heating, of the various lead components or tissue of the patient undergoing the MRI scan.
- components, controls and/or mechanisms can be provided to reduce or eliminate the amount of current or thermal energy induced within each tip electrode 36 a , 36 b , or increase an area over which the current or thermal energy can be dissipated.
- the IMD 20 can comprise an implantable cardiac device, such as an implantable pulse generator (IPG) 120 .
- IPG implantable pulse generator
- the IPG 120 that will be described herein can be similar to the IMD 20 described with reference to FIGS. 1-2 , similar reference numerals will be used to denote like components.
- the IPG 120 is illustrated herein as including one lead assembly, the IPG 120 can include any number of lead assemblies (e.g., a uni-polar, bipolar or multi-polar lead) depending upon the malady of the patient 40 .
- each lead assembly can include a switch assembly, as further discussed herein.
- the IPG 120 can be used to generate electronic pulses to treat bradycardia, and thus, can deliver a therapy to a desired location within the heart 42 .
- the IPG 120 can receive electrical pulses (sensing) from the heart 42 to enable the IPG 120 to monitor the heart rhythm to determine if a therapy is needed.
- the IPG 120 can comprise any suitable IPG, such as one selected from the ADAPTATM family of IPGs available from Medtronic, Inc. of Minneapolis, Minn., only the modified or augmented portions of the IPG 120 will be discussed in great detail herein.
- the IPG 120 can include a control system 122 and at least one IPG stimulation lead 124 which can be implanted into an anatomical structure, similar to the placement of the IMD 20 relative to the heart 42 , as shown in FIG. 2 .
- the control system 122 and the at least one IPG stimulation lead 124 can cooperate to reduce or eliminate the current or thermal energy induced in at least one tip electrode associated with the IPG stimulation lead 124 , as will be discussed.
- the control system 122 can include a controller 122 a , a pulse generator 122 b and a field sensor 122 c that form specific parts of the controller assembly 26 , illustrated in the IMD 20 discussed with regard to FIGS. 1 and 2 .
- the controller 122 a can be in communication with and responsive to the programmer 50 to receive a desired treatment plan for the heart 42 , such as a desired voltage for the electrical stimulation of the heart 42 .
- the controller 122 a can also be in communication with the lead 124 to receive the sensed electrical activity of the heart 42 , as will be discussed.
- the pulse generator 122 b can be in communication with and responsive to the controller 122 a to generate the desired therapy (i.e., electrical stimulation or pulse) for the heart 42 .
- the pulse generator 122 b can be in electrical communication with the lead 124 to supply the lead 124 with the desired therapy.
- the field sensor 122 c can be responsive to an external field, such as that generated by a MRI scan.
- the field sensor 122 c can be capable of detecting multi-level field strengths and/or can be capable of discriminating between different field ranges.
- the field sensor 122 c can comprise a Hall effect sensor or the magnetic field sensor 60 disclosed in commonly assigned U.S. Pat. No. 7,050,855, incorporated herein by reference.
- the field sensor 122 c can also be an RF field sensor, as known in the art or can comprise another suitable field sensor used to detect an external field.
- the field sensor 122 c can be in communication with the controller 122 a to transmit a signal indicative of the surrounding field, such as whether the patient 40 is undergoing a MRI scan.
- the controller 122 a can adjust the voltage and location of the electrical therapy provided by the lead 124 to the heart 42 , and optionally can also communicate the presence of the field to an optional field control system 132 of the lead 124 , if employed, as will be discussed.
- the lead 124 can both sense the electrical activity of the heart 42 and can also deliver electrical energy to pace the heart 42 .
- the lead 124 can include a proximal end 134 , a distal end 136 , a body 138 , at least one first or ring electrode 140 , at least one second or tip electrode assembly 142 , a switch assembly 144 and optionally, the field control system 132 .
- the proximal end 134 , the distal end 136 and the body 138 of the lead 124 can comprise any suitable proximal end, distal end and body, such as that associated with the CAPSUREFIXTM line of cardiac leads available from Medtronic, Inc.
- the proximal end 134 of the lead 124 can include a connector terminal 30 ( FIG. 1 ) that can electrically couple the lead 124 to the connector body 27 of the IPG 120 .
- the distal end 136 can terminate within the anatomical structure adjacent to the desired location for the delivery of the therapy to the heart 42 , as generally known, and illustrated in FIG. 2 .
- the ring electrode 140 and the tip electrode 142 b can be coupled at or near the distal end 136 to deliver a therapy to an atrium A of the heart 42 ( FIG. 2 ). It will be understood, however, that the ring electrode 140 and the tip electrode 142 b can be coupled at any desired location along the body 138 of the lead 124 .
- the body 138 of the lead 124 can extend from the proximal end 134 to the distal end 136 .
- the body 138 of the lead 124 can comprise a bifilar coil 148 .
- the bifilar coil 148 can include a pacing transmission member or pacing conductor 150 and at least one or multiple sensing/control transmission members or sensing/control conductors 152 .
- the pacing conductor 150 and the sensing/control conductor 152 can each be insulated to conduct or carry electrical signals along the body 138 of the lead 124 .
- the pacing conductor 150 can be in communication with the pulse generator 122 b to conduct or carry electrical pulses from the IPG 120 to the ring electrode 140 or the tip electrode assembly 142 to pace the heart 42 .
- a first sensing/control conductor 152 a can be in communication with the controller 122 a of the IPG 120 , and can conduct or carry electrical signals that indicate the electrical activity of the heart 42 , as sensed by the ring electrode 140 , as will be discussed.
- a second sensing/control conductor 152 b can be in communication with the controller 122 a and a drive circuit 144 c of the switch assembly 144 to control activation of the switch assembly 144 .
- a third sensing/control conductor 152 c can be in communication with the field control system 132 of the lead to conduct or carry electrical signals to the controller 122 a that can indicate the presence of an external field, as will be discussed.
- a fourth sensing/control conductor 152 d can be in communication with the controller 122 a of the IPG 120 and the optional field control system 132 to conduct or carry electrical signals between the control systems 122 , 132 .
- the ring electrode 140 can be disposed near the distal end 136 of the lead 124 ( FIG. 3 ).
- the ring electrode 140 can be generally annular, and can include an outer surface 140 a and an inner surface 140 b , as shown in FIG. 4 .
- the outer surface 140 a can be adjacent to the anatomical structure, such as the heart 42 .
- the outer surface 140 a of the ring electrode 140 can have a surface area that can range from about 0.5 square millimeters to about 40 square millimeters. Generally, the surface area of the ring electrode 140 can be about equal to or greater than a surface area of the tip electrode 142 b .
- the outer surface 140 a can enable the ring electrode 140 to sense the electrical activity of the heart 42 .
- control system 122 can be in communication with the ring electrode 140 , via the first sensing/control conductor 152 a to receive the sensed electrical activity of the heart 42 .
- the controller 122 a of the IPG 120 can determine if a therapy is needed for the patient 40 .
- the inner surface 140 b of the ring electrode 140 can be in electrical communication with the switch assembly 144 via a ring contact 144 a .
- the switch assembly 144 can selectively electrically decouple the ring electrode 140 from the IPG 120 in a second operational state, briefly re-coupling to sense or deliver therapy as further discussed herein.
- the tip electrode assembly 142 can also be in communication or electrically coupled with the switch assembly 144 to receive the electrical pulses from the IPG 120 in a first operational state (i.e., no external field detected).
- the tip electrode assembly 142 can include a transmission coil 142 a , a tip electrode 142 b and optionally, a fixation mechanism 142 c .
- the transmission coil 142 a and the tip electrode 142 b can be in electrical communication with the switch assembly 144 to deliver the therapy to the anatomical tissue at a tip contact 144 b .
- the tip electrode 142 b can also have a surface area that can range from about 0.5 square millimeters to about 40 square millimeters, which can be smaller than the surface area of the ring electrode 140 .
- the fixation mechanism 142 c if employed, can be used to secure the tip electrode assembly 142 to a desired location in the anatomical tissue, such as the heart 42 , as illustrated in FIG. 2 .
- the transmission coil 142 a in the first operational state, can receive the therapy generated by the IPG 120 through the tip contact 144 b of the switch assembly 144 , and can conduct the therapy to the tip electrode 142 b to deliver the therapy to the heart 42 .
- the transmission coil 142 a in a second operational state (i.e., external field detected), can be electrically decoupled from the IPG 120 at the switch assembly 144 such that the transmission coil 142 a does not receive any therapy generated by the IPG 120 .
- the switch assembly 144 in the second operational state, can electrically decouple the ring electrode 140 through the ring contact 144 a , such that the ring electrode 140 is electrically isolated from the IPG 120 .
- the in the tip electrode assembly 142 and the ring electrode 140 are selectively and briefly re-couple in synchrony to the delivery of the therapy (e.g., a pacing pulse).
- the tip electrode assembly 142 and/or the ring electrode 140 are then decoupled again, so that during the MRI scan the tip electrode assembly 142 and the ring electrode 140 are de-coupled approximately 95% of the time.
- the slight heating that may occur during the period of being coupled would not be detrimental to the IPG 20 or the patient.
- the switch assembly 144 can thereby prevent induced currents from flowing to a smaller surface area electrode assembly, such as the tip electrode assembly 142 while continuing to provide therapy to the patient.
- the switch assembly 144 can be any suitable switch that is capable of electrically coupling the electrical pulses generated by the pulse generator 122 b to either the ring electrode 140 or the tip electrode assembly 142 , such as a transistor, a micro-electrical mechanical switch, etc. Illustrated schematically in FIGS. 4 and 5 , the switch assembly 144 can include the ring contact 144 a , the tip contact 144 b and a drive circuit 144 c .
- the ring contact 144 a can electrically couple the switch assembly 144 to the ring electrode 140 , via contact between the ring contact 144 a and the inner surface 140 b of the ring electrode 140 , for example, which can thereby result in a unipolar pacing scheme.
- the tip contact 144 b can electrically couple the switch assembly 144 to the tip electrode assembly 142 , via contact between the tip contact 144 b and the transmission coil 142 a of the tip electrode assembly 142 , which can thereby result in a bipolar pacing scheme.
- the drive circuit 144 c can trigger or activate the switch assembly 144 .
- the drive circuit 144 c can comprise any suitable device capable of activating the switch assembly 144 , such as a solenoid, as generally known in the art.
- the drive circuit 144 c can be in communication with and responsive to the controller 122 a and the optional field control system 132 to activate the switch assembly 144 to electrically couple either the ring electrode 140 or the tip electrode assembly 142 to the pacing conductor 150 .
- the optional field control system 132 includes a controller 132 a and a field sensor 132 b .
- the controller 132 a and field sensor 132 b will be illustrated herein in phantom.
- the controller 132 a can be in communication with and responsive to the controller 122 a of the IPG 120 to receive a signal that indicates whether an external field is present, based on data received from the field sensor 122 c .
- the controller 132 a can be in communication with and responsive to the field sensor 132 b , and can be in communication with the switch assembly 144 . Based on the data received from the field sensor 132 b , the controller 132 a can transmit a signal to the controller 122 a of the IPG 120 , via the sensing/control conductor 152 d , which can indicate that an external field is present. In addition, based on the data received from the field sensor 132 b , and the controller 122 a , the controller 132 a can transmit a signal to the switch assembly 144 to electrically couple either the ring electrode 140 or the tip electrode assembly 142 to the pacing conductor 150 to receive the therapy from the IPG 120 .
- the field sensor 132 b can be responsive to an external field, such as that generated by a MRI scan, and can be capable of detecting multi-level field strengths and/or can be capable of discriminating between different field ranges.
- the field sensor 132 b can be substantially similar to the field sensor 122 c.
- the lead 124 can include the ring electrode 140 and the tip electrode 142 b .
- the ring electrode 140 can have a surface area that is greater than the surface area of the tip electrode 142 b , as discussed.
- the ring electrode 140 can further house the switch assembly 144 .
- the pacing conductor 150 can carry a current from the pulse generator 122 b to the switch assembly 144 .
- the switch assembly 144 can be activated by the IPG 120 .
- the controller 122 a can determine if the external field is present. If the external field is present, then the controller 122 a can output a signal to activate the switch assembly 144 to switch from the first operational state to the second operational state.
- the switch assembly 144 can be activated by the IPG 120 and the field sensor 132 b .
- the controller 122 a can determine if the external field is present. If the external field is present, then the controller 122 a can output a signal to activate the switch assembly 144 to switch from the first operational state to the second operational state. The controller 122 a can also determine if the signal from the field sensor 122 c and the signal from the field sensor 132 b are about equal.
- the controller 122 a can output error data for the programmer 50 that can indicate that one of the field sensor 122 c and field sensor 132 b has failed.
- the switch assembly 144 can be activated by the control system 122 of the IPG 120 and the field control system 132 of the lead 124 .
- the controller 122 a can output a signal for the controller 132 a that can indicate if an external field is present. If the external field is present, then the controller 122 a can output a signal to activate the switch assembly 144 to switch from the first operational state to the second operational state where the tip electrode 142 and the ring electrode 140 and selectively and briefly re-coupled to delivery therapy and then decoupled again from the IPG 120 so reduce heating of components or tissue.
- the field controller 132 a can receive the signal from the controller 122 a that indicates if the external field is present, and can receive the signal from the field sensor 132 b that indicates if the external field is present.
- the controller 132 a can determine if the signal from the field sensor 122 c and the signal from the field sensor 132 b are about equal. If the signal from the field sensor 122 c and the signal from the field sensor 132 b are not about equal, then the controller 132 a can output a signal for the controller 122 a such that the controller 122 a can output error data for the programmer 50 .
- the controller 132 a can also output a signal for the drive circuit 144 c to activate the switch assembly 144 to electrically decouple and re-couple tip electrode 142 and the ring electrode 140 to the IPG 120 in the second operational state such that therapy can continue to be delivered during an MRI scan.
- the switch assembly 144 can be in contact with the tip contact 144 b , such that the current from the IPG 120 can flow to the tip electrode 142 b , via the transmission coil 142 a , in the first operational state (i.e., no external field detected). If the lead 124 is in the presence of the external field, then the switch assembly 144 can decouple the tip electrode 142 while allowing the ring electrode 140 to remain connected for sensing purposes, in the second operational state. Thus, in the presence of an external field, the tip electrode 142 b can be electrically decoupled from the lead 124 , which thereby reduces the effective length of the lead 124 .
- the amount of current or thermal energy induced in the lead 124 can depend upon a length of the lead 124 .
- the length of the lead 124 can be illustrated as L 1 ( FIG. 5 )
- the length L 2 of the lead 124 can be illustrated as L 2
- the tip electrode 142 b is electrically decoupled from the lead 124 .
- the tip electrode 142 b can be decoupled from the IPG 120 to further reduce the electrical length of the lead 124 .
- a dataflow diagram illustrates an exemplary control system 198 that can be embedded within the controller 122 a of the IPG 120 and/or the controller 132 a of the lead 124 .
- Various embodiments of the control system 198 according to the present disclosure can include any number of sub-modules embedded within the controller 122 a of the IPG 120 and/or the controller 132 a of the lead 124 .
- the sub-modules shown may be combined and/or further partitioned to similarly deliver a therapy to an anatomical tissue, such as the heart 42 , in the presence of an external field, such as that encountered during a MRI scan.
- Inputs to the system can be received from the field sensors 122 c , 132 b , or even received from other control modules within the IPG 120 , and/or determined by other sub-modules within the controller 122 a of the IPG 120 and/or the controller 132 a of the lead 124 .
- the control system 198 includes the controller 122 a of the IPG 120 that can implement an IPG control module 200 and the controller 132 a of the lead 124 that can implement a lead control module 202 .
- the IPG control module 200 can be implemented by the controller 122 a of the IPG 120 and the lead control module 202 can be implemented by the optional controller 132 a of the lead 124 , both of the IPG control module 200 and the lead control module 202 can be implemented by the controller 122 a of the IPG 120 , if desired.
- the IPG control module 200 can include an IPG field control module 204 and a pacing control module 206 .
- the IPG field control module 204 can receive as input IPG field sensor data 212 .
- the IPG field sensor data 212 can comprise a signal from the field sensor 122 c and optionally, the field sensor 132 b if employed, that can be used to determine whether or not an external field is present.
- the IPG field control module 204 sets field data 214 for the pacing control module 206 and the lead control module 202 .
- the field data 214 can comprise data that indicates whether an external field, such as that generated by a MRI scan, is present.
- the pacing control module 206 can receive as input the field data 214 , heart rhythm data 216 and programmer data 218 .
- the heart rhythm data 216 can comprise the electrical activity of the anatomical tissue, such as the heart 42 , as sensed by the ring electrode 140 .
- the programmer data 218 can comprise data received from the programmer 50 , such as a desired therapy to be output by the IPG 120 based on the presence of an external field, such as that generated by a MRI scan.
- the IPG 120 produces a pacing therapy at about 0.01 volts (V), however, this voltage value is programmable to achieve capture of the patient's heart muscle so that the pacing therapy can be effectively delivered.
- the pacing control module 206 Based on the field data 214 , the heart rhythm data 216 and the programmer data 218 , the pacing control module 206 outputs pacing data 220 .
- the pacing data 220 comprises a desired therapy for the anatomical tissue, such as to enter the second operational state where the tip electrode 142 and ring electrode 140 are first decoupled from the IPG 120 and then selectively and briefly re-coupled to the IPG 120 for the delivery of therapy during the MRI scan. When the patient is no longer in the presence of the MRI field, then the pacing data 220 can re-couple the tip electrode 142 and ring electrode 140 to resume normal pacing operation in the first operational state.
- the pacing control module 206 Based on the field data 214 , the heart rhythm data 216 and the programmer data 218 , the pacing control module 206 outputs pacing data 220 .
- the pacing data 220 comprises a desired therapy for the anatomical tissue, such as a desired electrical pulse to stimulate the heart 42 .
- the pacing control module 206 determines that the heart 42 requires a pacing therapy, then, based on whether the patient 40 is undergoing a MRI scan, as indicated by the field data 214 and/or the programmer data 218 , the pacing control module 206 outputs the appropriate level of therapy as pacing data 220 .
- the pacing data 220 can instruct the pulse generator 122 c to generate the desired therapy for the anatomical tissue.
- the lead control module 202 can receive as input lead field sensor data 224 , heart rhythm data 216 and field data 214 .
- the lead field sensor data 224 can be optional, and can comprise a signal from the field sensor 132 b that can be used to determine whether or not an external field is present, such as that generated during a MRI scan. Based on the lead field sensor data 224 , heart rhythm data 216 and field data 214 , the lead control module 202 can output switch data 226 and, optionally, error data 228 .
- the switch data 226 can comprise a signal to the switch assembly 144 to drive the drive circuit 144 c to electrically decouple or re-couple either the ring electrode 140 and/or the tip electrode assembly 142 to the IPG 120 based on whether an external field is present. If it is determined that an external field is present, based on the lead field sensor data 224 and/or field data 214 , then the switch data 226 can comprise a signal to electrically decouple the ring electrode 140 and/or the ring electrode to the IPG 120 in the second operational state as described above. If it is determined that an external field is not present, then the switch data 226 can comprise a signal to electrically re-couple the tip electrode assembly 142 and the ring electrode 140 to the to the IPG 120 to return to the normal first operational state.
- the error data 228 can comprise a signal transmitted to the programmer 50 that there is an error associated with either the field sensor 122 c of the IPG 120 or the field sensor 132 b of the lead 124 , if employed.
- the lead control module 202 can output the error data 228 to indicate that there is a problem with either the field sensor 122 c of the IPG 120 or the field sensor 132 b of the lead 124 .
- a process flow diagram illustrates an exemplary method that can be performed by the control system 198 .
- the method can obtain the IPG field sensor data 212 from the field sensor 122 c of the IPG 120 .
- the method can obtain the lead field sensor data 224 from the field sensor 132 b of the lead 124 , if employed.
- the method can determine if the lead field sensor data 224 from the field sensor 132 b is about equal to the IPG field sensor data 212 from the field sensor 122 c .
- the method goes to decision block 306 . Otherwise, the method can output error data 228 at block 308 and then go to decision block 306 .
- the method determines if the field present is greater than a threshold field.
- the threshold field can be equivalent to a field generated during a MRI procedure, and thus, can comprise a threshold value for a magnetic field or a threshold value for an electrical field. Further, the threshold field can be a value programmed into the IPG 120 by the programmer 50 . If the field present is greater than the threshold field, then the method can go to block 310 . Otherwise, the method can go to block 312 .
- the method re-couples the tip electrode 142 and ring electrode 130 to the IPG 120 if they had been previously decoupled in block 310 . Then, the method can loop to block 300 .
- the method can activate the switch assembly 144 to electrically decouple the IPG 120 from the tip electrode assembly 142 and ring electrode 140 such that the tip electrode assembly 142 cannot deliver the desired therapy to the heart 42 and the ring electrode 140 is not sensing the heart. Then, at block 316 , the method can briefly re-couple the tip electrode 142 and the ring electrode 140 to deliver therapy from the IPG to the patient. Then, at block 318 , the method can again decouple the tip electrode 142 and the ring electrode 140 and loop to block 300 to again determine whether the patient remains in the external field; that is in one embodiment, having an MRI scan performed.
- the method can adjust decouple/re-couple timing so that the tip electrode 142 and the ring electrode 140 are decoupled approximately 95% of the time to reduce heating of the IPG components as well as the tissue adjacent to the tip electrode 142 .
Abstract
An implantable medical device (IMD) can include an implantable pulse generator (IPG), such as a cardiac pacemaker or an implantable cardioverter-defibrillator (ICD). Various portions of the IMD, such as a device body, a lead body, or a lead tip, can be provided to reduce or dissipate a current and heat induced by various external environmental factors. According to various embodiments, features can be incorporated into the lead body, the lead tip, or the IMD body to reduce the creation of an induced current, or dissipate the induced current and heat created due to an induced current in the lead.
Description
- The present disclosure relates to implantable medical devices (IMDs), in particular to a system and method for use of a cardiac lead that includes a switch responsive to an external field, such as that generated during a magnetic resonance imaging (MRI) procedure.
- The statements in this section merely provide background information related to the present disclosure and may not constitute prior art.
- The human anatomy includes many types of tissue that can either voluntarily or involuntarily, perform certain functions. However, after disease or injury, certain tissues may no longer operate within general anatomical norms. For example, after disease, injury, age, or combinations thereof, the heart muscle may begin to experience certain failures or deficiencies. Some of these failures or deficiencies can be corrected or treated with implantable medical devices (IMDs). These devices can include implantable pulse generator (IPG) devices, pacemakers, implantable cardioverter-defibrillator (ICD) devices, cardiac resynchronization therapy defibrillator devices, or combinations thereof.
- One of the main portions of the IMD can include a lead that is directly connected to tissue to be affected by the IMD. The lead can include a tip portion that is directly connected to the anatomical tissue, such as a muscle bundle, and a lead body that connects to the device body or therapeutic driving device. It is generally known that the device body or case portion can be implanted in a selected portion of the anatomical structure, such as in a chest or abdominal wall, and the lead can be inserted through various venous portions so that the tip portion can be positioned at the selected position near or in the muscle group.
- The IMD generally remains with the patient during the rest of the patient's natural life. To that end, the IMD can be exposed to various environmental factors. For example, the patient may undergo a magnetic resonance imaging (MRI) procedure or other high frequency imaging procedures. In this case, portions of the IMD may act as an antenna and have current and thermal energy induced therein due to the MRI procedure. This induced heat can damage anatomical tissue and cause injury to the patient. Accordingly, reduction or dissipation of the induced current or thermal energy may be useful in certain circumstances.
- An implantable medical device (IMD) can include implantable pulse generator (IPG) devices, implantable cardioverter-defibrillators (ICD), cardiac resynchronization therapy defibrillator devices, neurostimulators or combinations thereof. The IMD can be positioned in a selected portion of the anatomical structure, such as a chest wall or abdominal wall, and a lead can be positioned through a vein or transvenously so that a lead tip can be implanted in a portion of the cardiac or heart muscle. Various portions of the IMD, such as a case or device body, the lead body, or the lead tip, can be formed or augmented to reduce or dissipate heat production due to various external environmental factors. For example, a magnetic and/or electric field from a magnetic resonance imager (MRI), diathermy (including shortwave, microwave, ultrasound, or the like) or other energy field producing devices can induce currents in the lead. According to various embodiments, features or portions can be incorporated into the lead body, the lead tip, or the device body to reduce the creation of an induced current, or dissipate or increase the area of dissipation of thermal energy created due to an induced current in the lead.
- An implantable medical device operable to provide therapy to an anatomical tissue is provided. The device can include a lead having a body. For a uni-polar lead, the body of the lead can have at least one conductor to transmit the therapy through the body of the lead. The device can further include at least one tip electrode coupled to the body of the lead. The at least one tip electrode can be in electrical communication with the at least one conductor to deliver the therapy to a portion of the anatomical tissue in a first operational state. In a second operational state, the at least one tip electrode can be selectively decoupled from the at least one conductor to reduce heating in the presence of a magnetic and/or electric field (e.g., from a magnetic resonance imaging (MRI) device) and briefly re-coupled to the at least one conductor to deliver a pacing therapy before being decoupled again. In a bipolar lead, the device can also include at least one ring electrode fixedly coupled to the body of the lead. The at least one ring electrode can be in electrical communication with the at least one conductor to provide sensing or to deliver the therapy to the anatomical tissue in the first operational state. In a second operational state, the at least one tip and ring electrodes can be selectively decoupled from their respective conductors to reduce heating in the presence of a magnetic and/or electric field (e.g., from a magnetic resonance imaging (MRI) device) and briefly re-coupled to the conductors to deliver a pacing therapy before being decoupled again. The lead can switch between the first operational state and the second operational state based on whether an external field is present.
- In addition, an implantable medical device is also provided that includes a therapy device operable to generate the therapy for the anatomical tissue. The device can include a lead having a proximal end in electrical communication with the therapy device, a distal end and a body. The body of the lead can have at least one conductor to carry the therapy through the body of the lead. The device can further include at least one tip electrode coupled to the distal end of the lead that can be operable to deliver the therapy to a portion of the anatomical tissue. The device can include at least one ring electrode coupled to the lead that can be operable to provide sensing or to deliver the therapy to the anatomical tissue. The device can also include a switch that can electrically couple the at least one conductor to the at least one tip electrode and/or to the at least one ring electrode. The device can include at least one control system that can activate the switch to electrically couple the at least one conductor to the at least one tip electrode (and ring electrode in a bipolar lead) in a first operational state or to selectively electrically decouple the at least one conductor to the at least one ring electrode (and ring electrode in a bipolar lead) in a second operational state in the presence of an external field. The tip (or tip and ring) electrode is briefly re-coupled to the conductor(s) to deliver therapy before being decoupled again.
- Further provided is a method of controlling a cardiac lead implanted in an anatomical structure during the presence of an external field. The method can include providing a lead having at least one conductor passing through the lead, at least one first electrode in electrical communication with the at least one conductor to deliver a therapy to a portion of the anatomical tissue and at least one second electrode in electrical communication with the another conductor for sensing or to deliver a therapy to the anatomical tissue. The method can also include determining whether the external field is present and selectively electrically decoupling the at least one first electrode (and/or the at least one second electrode) in the presence of the external field and briefly re-couple the at least one first electrode (and/or the at least one second electrode) with the at least one conductor to deliver the therapy before being decoupled again. The method can include electrically re-coupling the at least one first and second electrode with the their respective conductors to deliver the therapy when the external field is no longer present.
- Further areas of applicability will become apparent from the description provided herein. It should be understood that the description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure.
- The drawings described herein are for illustration purposes only and are not intended to limit the scope of the present disclosure in any way.
-
FIG. 1 is a view of an IMD including a lead connected to a device body; -
FIG. 2 is a simplified environmental view of the IMD implanted in a patient; -
FIG. 3 is a simplified environmental view of an IPG that includes an exemplary cardiac lead system with a switch responsive to an external field, such as that generated during a magnetic resonance imaging (MRI) procedure; -
FIG. 4 is a simplified perspective view of a ring electrode and the switch of the cardiac lead system ofFIG. 3 ; -
FIG. 5 is a simplified schematic illustration of the IPG and cardiac lead system ofFIG. 3 ; -
FIG. 6 is a dataflow diagram illustrating a control system performed by the IPG; and -
FIG. 7 is a flowchart illustrating an exemplary method performed by the IPG. - The following description is merely exemplary in nature and is not intended to limit the present disclosure, application, or uses. It should be understood that throughout the drawings, corresponding reference numerals indicate like or corresponding parts and features. As indicated above, the present teachings are directed towards providing a system and method for use of a cardiac lead that includes a switch that is responsive to an external field, such as that generated by a MRI. It should be noted, however, that the present teachings could be applicable to any appropriate procedure in which it is desirable to have a component that is responsive to external fields. Further, as used herein, the term module refers to an application specific integrated circuit (ASIC), an electronic circuit, a processor (shared, dedicated, or group) and memory that executes one or more software or firmware programs, a combinational logic circuit, and/or other suitable software, firmware programs or components that provide the described functionality. Therefore, it will be understood that the following discussions are not intended to limit the scope of the appended claims.
- With reference to
FIG. 1 , an implantable medical device (IMD) 20, which can include implantable pulse generator (IPG) devices, implantable cardioverter-defibrillator (ICD) devices, cardiac resynchronization therapy defibrillator devices, or combinations thereof, is exemplarily illustrated. TheIMD 20 can include an implantable case orbody assembly 22. Theimplantable case 22 can be formed of appropriate materials and include appropriate features, such as a hermetically sealedbody wall 24. Thebody wall 24 can be made of a substantially inert material or of a conducting material. - Contained within or associated with the
case 22 can be a power device 25 (i.e., battery), acontroller assembly 26, and aconnector body 27. Thecontroller assembly 26 can include a circuit board having a processor, memory, transmitter, receiver, and other appropriation portions, further discussed herein. Theconnector body 27 can extend from or be integrated with thecase 22. Theconnector body 27 can includemultiple ports 28 that each interconnect with aconnector terminal 30 of alead assembly 32.FIG. 1 illustrates twolead assemblies lead assembly lead bodies tip electrodes IMD 20 is illustrated inFIGS. 1 and 2 as including twolead assemblies lead assemblies 32 could be employed with theIMD 20 depending upon the malady of the patient and theparticular IMD 20 employed. Moreover, the switch assembly further discussed herein can be associated with one or all of thelead assemblies particular IMD 20 employed. - A fixation mechanism can also be included with each
lead assembly tip electrode tip electrode tip electrode - A majority of each
lead body FIG. 4 ) can extend from eachconnector terminal 30 to engage eachtip electrode FIG. 4 ). It will be understood by one skilled in the art that the inner electrical conductor can be one piece or multiple components that are interconnected. Also, more than one inner electrical conductor can be provided, such as one inner electrical conductor for each electrode in eachlead assembly lead body - The
IMD 20, including the components discussed above, can be implanted in a patient 40 as illustrated inFIG. 2 . TheIMD 20 can include one or morelead assemblies 32, such as thefirst lead assembly 32 a and thesecond lead assembly 32 b. Thefirst lead assembly 32 a and thesecond lead assembly 32 b can be connected to theconnector body 27. As one skilled in the art will understand, the position oflead bodies patient 40. For example, thelead assemblies heart 42 or on the outside of theheart 42. TheIMD 20 can be provided to pace theheart 42, defibrillate theheart 42, sense conditions of theheart 42, etc. - The
IMD 20, including thecase 22 and thelead bodies patient 40 and thelead assemblies heart 42 of thepatient 40. Thecase 22 can also be positioned through the incision into a chest wall or abdominal wall of thepatient 40. In a selected procedure, theleads assemblies superior vena cava 44 of thepatient 40. The lead tips ortip electrodes heart 42, such as at the ventricles or atriums thereof. The position of thelead assemblies tip electrodes tip electrodes patient 40, the surgeon performing the procedure, the specifics of thelead assemblies - As discussed above, the
IMD 20, including thecase 22 and thelead assemblies heart 42. The controls can include a processor associated with thecontroller assembly 26 located within thecase 22. The processor can be programmed to control driving a current through thelead bodies tip electrodes heart 42. - With continued reference to
FIG. 2 , a programmer orprogramming system 50 can be provided. Theprogrammer 50 can include a telemetry system that is operable to wirelessly transmit a signal to the processor within thecase 22. It will be understood that a wired communication system can also be used. In addition, an induction system can be used where a coil is positioned near thecase 22 and a signal is sent from theprogrammer 50 via induction. Theprogrammer 50 can also receive information from the IMD 20 (e.g. tachycardia rhythms, times and programming settings) to assist in providing an appropriate program for therapy and to determine if theIMD 20 is operating properly. Theprogrammer 50 can include any appropriate programming system, including one generally known to those skilled in the art, such as the Medtronic CARELINK™ programmer, sold by Medtronic, Inc. of Minneapolis, Minn. - Moreover, the
IMD 20, including thecase 22 and thelead assemblies lead assemblies lead assemblies - For example, according to various embodiments, the patient 40 which has the implanted
IMD 20 may receive a certain therapy or diagnostic technique, such as a magnetic resonance image (MRI) scan. Although not illustrated, a MRI, generally understood by one skilled in the art, uses high frequency radio frequency (RF) pulses and strong magnetic fields to create image data regarding thepatient 40. Generally, a MRI will have a frequency of about 42 MHz per tesla. Many common MRI systems use about 1.5 tesla magnetic fields and have a corresponding RF frequency of about 64 MHz. Without being bound by the theory, the strong magnetic fields in a MRI can induce aligned spins of sub-atomic particles and the high frequency RF pulses can be used to change the alignment or otherwise affect the sub-atomic particles within thepatient 40. - The strong magnetic fields and RF pulses may induce currents within the
lead assemblies IMD 20. The current induced in thelead assemblies tip electrode - According to various embodiments, and with reference to
FIG. 3 , in one example theIMD 20 can comprise an implantable cardiac device, such as an implantable pulse generator (IPG) 120. As theIPG 120 that will be described herein can be similar to theIMD 20 described with reference toFIGS. 1-2 , similar reference numerals will be used to denote like components. It should be noted that, while theIPG 120 is illustrated herein as including one lead assembly, theIPG 120 can include any number of lead assemblies (e.g., a uni-polar, bipolar or multi-polar lead) depending upon the malady of thepatient 40. Moreover, each lead assembly can include a switch assembly, as further discussed herein. With continued reference toFIGS. 3-5 , in one example, theIPG 120 can be used to generate electronic pulses to treat bradycardia, and thus, can deliver a therapy to a desired location within theheart 42. In addition, theIPG 120 can receive electrical pulses (sensing) from theheart 42 to enable theIPG 120 to monitor the heart rhythm to determine if a therapy is needed. As theIPG 120 can comprise any suitable IPG, such as one selected from the ADAPTA™ family of IPGs available from Medtronic, Inc. of Minneapolis, Minn., only the modified or augmented portions of theIPG 120 will be discussed in great detail herein. - The
IPG 120 can include acontrol system 122 and at least oneIPG stimulation lead 124 which can be implanted into an anatomical structure, similar to the placement of theIMD 20 relative to theheart 42, as shown inFIG. 2 . With reference toFIGS. 3-5 , thecontrol system 122 and the at least oneIPG stimulation lead 124 can cooperate to reduce or eliminate the current or thermal energy induced in at least one tip electrode associated with theIPG stimulation lead 124, as will be discussed. Thecontrol system 122 can include acontroller 122 a, apulse generator 122 b and afield sensor 122 c that form specific parts of thecontroller assembly 26, illustrated in theIMD 20 discussed with regard toFIGS. 1 and 2 . - The
controller 122 a can be in communication with and responsive to theprogrammer 50 to receive a desired treatment plan for theheart 42, such as a desired voltage for the electrical stimulation of theheart 42. Thecontroller 122 a can also be in communication with thelead 124 to receive the sensed electrical activity of theheart 42, as will be discussed. Thepulse generator 122 b can be in communication with and responsive to thecontroller 122 a to generate the desired therapy (i.e., electrical stimulation or pulse) for theheart 42. Thepulse generator 122 b can be in electrical communication with thelead 124 to supply thelead 124 with the desired therapy. - The
field sensor 122 c can be responsive to an external field, such as that generated by a MRI scan. In this regard, thefield sensor 122 c can be capable of detecting multi-level field strengths and/or can be capable of discriminating between different field ranges. For example, thefield sensor 122 c can comprise a Hall effect sensor or the magnetic field sensor 60 disclosed in commonly assigned U.S. Pat. No. 7,050,855, incorporated herein by reference. Thefield sensor 122 c can also be an RF field sensor, as known in the art or can comprise another suitable field sensor used to detect an external field. Thefield sensor 122 c can be in communication with thecontroller 122 a to transmit a signal indicative of the surrounding field, such as whether thepatient 40 is undergoing a MRI scan. Based on the signal received from thefield sensor 122 c, thecontroller 122 a can adjust the voltage and location of the electrical therapy provided by thelead 124 to theheart 42, and optionally can also communicate the presence of the field to an optionalfield control system 132 of thelead 124, if employed, as will be discussed. - With reference to
FIGS. 3-5 , thelead 124 can both sense the electrical activity of theheart 42 and can also deliver electrical energy to pace theheart 42. Thelead 124 can include aproximal end 134, adistal end 136, abody 138, at least one first orring electrode 140, at least one second ortip electrode assembly 142, aswitch assembly 144 and optionally, thefield control system 132. As theproximal end 134, thedistal end 136 and thebody 138 of thelead 124 can comprise any suitable proximal end, distal end and body, such as that associated with the CAPSUREFIX™ line of cardiac leads available from Medtronic, Inc. of Minneapolis, Minn., only the modifications or augmentations to theproximal end 134, thedistal end 136 and thebody 138 of thelead 124 will be discussed in great detail herein. Theproximal end 134 of thelead 124 can include a connector terminal 30 (FIG. 1 ) that can electrically couple thelead 124 to theconnector body 27 of theIPG 120. - The
distal end 136 can terminate within the anatomical structure adjacent to the desired location for the delivery of the therapy to theheart 42, as generally known, and illustrated inFIG. 2 . As will be discussed, thering electrode 140 and thetip electrode 142 b can be coupled at or near thedistal end 136 to deliver a therapy to an atrium A of the heart 42 (FIG. 2 ). It will be understood, however, that thering electrode 140 and thetip electrode 142 b can be coupled at any desired location along thebody 138 of thelead 124. Thebody 138 of thelead 124 can extend from theproximal end 134 to thedistal end 136. Thebody 138 of thelead 124 can comprise abifilar coil 148. Thebifilar coil 148 can include a pacing transmission member orpacing conductor 150 and at least one or multiple sensing/control transmission members or sensing/control conductors 152. - The
pacing conductor 150 and the sensing/control conductor 152 can each be insulated to conduct or carry electrical signals along thebody 138 of thelead 124. As best shown inFIG. 5 , thepacing conductor 150 can be in communication with thepulse generator 122 b to conduct or carry electrical pulses from theIPG 120 to thering electrode 140 or thetip electrode assembly 142 to pace theheart 42. A first sensing/control conductor 152 a can be in communication with thecontroller 122 a of theIPG 120, and can conduct or carry electrical signals that indicate the electrical activity of theheart 42, as sensed by thering electrode 140, as will be discussed. A second sensing/control conductor 152 b can be in communication with thecontroller 122 a and adrive circuit 144 c of theswitch assembly 144 to control activation of theswitch assembly 144. A third sensing/control conductor 152 c can be in communication with thefield control system 132 of the lead to conduct or carry electrical signals to thecontroller 122 a that can indicate the presence of an external field, as will be discussed. A fourth sensing/control conductor 152 d can be in communication with thecontroller 122 a of theIPG 120 and the optionalfield control system 132 to conduct or carry electrical signals between thecontrol systems - The
ring electrode 140 can be disposed near thedistal end 136 of the lead 124 (FIG. 3 ). Thering electrode 140 can be generally annular, and can include anouter surface 140 a and aninner surface 140 b, as shown inFIG. 4 . Theouter surface 140 a can be adjacent to the anatomical structure, such as theheart 42. Theouter surface 140 a of thering electrode 140 can have a surface area that can range from about 0.5 square millimeters to about 40 square millimeters. Generally, the surface area of thering electrode 140 can be about equal to or greater than a surface area of thetip electrode 142 b. Theouter surface 140 a can enable thering electrode 140 to sense the electrical activity of theheart 42. In this regard, thecontrol system 122 can be in communication with thering electrode 140, via the first sensing/control conductor 152 a to receive the sensed electrical activity of theheart 42. As will be discussed, based on the sensed electrical activity of theheart 42, thecontroller 122 a of theIPG 120 can determine if a therapy is needed for thepatient 40. - The
inner surface 140 b of thering electrode 140 can be in electrical communication with theswitch assembly 144 via aring contact 144 a. As will be discussed, theswitch assembly 144 can selectively electrically decouple thering electrode 140 from theIPG 120 in a second operational state, briefly re-coupling to sense or deliver therapy as further discussed herein. - With reference to
FIGS. 3-5 , thetip electrode assembly 142 can also be in communication or electrically coupled with theswitch assembly 144 to receive the electrical pulses from theIPG 120 in a first operational state (i.e., no external field detected). Thetip electrode assembly 142 can include atransmission coil 142 a, atip electrode 142 b and optionally, afixation mechanism 142 c. Thetransmission coil 142 a and thetip electrode 142 b can be in electrical communication with theswitch assembly 144 to deliver the therapy to the anatomical tissue at atip contact 144 b. Thetip electrode 142 b can also have a surface area that can range from about 0.5 square millimeters to about 40 square millimeters, which can be smaller than the surface area of thering electrode 140. Thefixation mechanism 142 c, if employed, can be used to secure thetip electrode assembly 142 to a desired location in the anatomical tissue, such as theheart 42, as illustrated inFIG. 2 . - With reference to
FIG. 4 , in the first operational state, thetransmission coil 142 a can receive the therapy generated by theIPG 120 through thetip contact 144 b of theswitch assembly 144, and can conduct the therapy to thetip electrode 142 b to deliver the therapy to theheart 42. In a second operational state (i.e., external field detected), thetransmission coil 142 a can be electrically decoupled from theIPG 120 at theswitch assembly 144 such that thetransmission coil 142 a does not receive any therapy generated by theIPG 120. Further, in the second operational state, theswitch assembly 144 can electrically decouple thering electrode 140 through thering contact 144 a, such that thering electrode 140 is electrically isolated from theIPG 120. This can reduce an amount of current or thermal energy that may be induced in thetip electrode assembly 142 and/or thering electrode 140 by an external field, such as an external field generated by a MRI scan, since thetip electrode assembly 142 and thering electrode 140 is essentially electronically decoupled from thelead 124 in the second operational state. However, to continue to provide therapy to the patient during the MRI scan, the in thetip electrode assembly 142 and thering electrode 140 are selectively and briefly re-couple in synchrony to the delivery of the therapy (e.g., a pacing pulse). Thetip electrode assembly 142 and/or thering electrode 140 are then decoupled again, so that during the MRI scan thetip electrode assembly 142 and thering electrode 140 are de-coupled approximately 95% of the time. The slight heating that may occur during the period of being coupled would not be detrimental to theIPG 20 or the patient. Thus, theswitch assembly 144 can thereby prevent induced currents from flowing to a smaller surface area electrode assembly, such as thetip electrode assembly 142 while continuing to provide therapy to the patient. - With continued reference to
FIGS. 3-5 , theswitch assembly 144 can be any suitable switch that is capable of electrically coupling the electrical pulses generated by thepulse generator 122 b to either thering electrode 140 or thetip electrode assembly 142, such as a transistor, a micro-electrical mechanical switch, etc. Illustrated schematically inFIGS. 4 and 5 , theswitch assembly 144 can include thering contact 144 a, thetip contact 144 b and adrive circuit 144 c. Thering contact 144 a can electrically couple theswitch assembly 144 to thering electrode 140, via contact between thering contact 144 a and theinner surface 140 b of thering electrode 140, for example, which can thereby result in a unipolar pacing scheme. Thetip contact 144 b can electrically couple theswitch assembly 144 to thetip electrode assembly 142, via contact between thetip contact 144 b and thetransmission coil 142 a of thetip electrode assembly 142, which can thereby result in a bipolar pacing scheme. Thedrive circuit 144 c can trigger or activate theswitch assembly 144. Thedrive circuit 144 c can comprise any suitable device capable of activating theswitch assembly 144, such as a solenoid, as generally known in the art. Thedrive circuit 144 c can be in communication with and responsive to thecontroller 122 a and the optionalfield control system 132 to activate theswitch assembly 144 to electrically couple either thering electrode 140 or thetip electrode assembly 142 to thepacing conductor 150. - The optional
field control system 132 includes acontroller 132 a and afield sensor 132 b. As thefield control system 132 can be optional, thecontroller 132 a andfield sensor 132 b will be illustrated herein in phantom. If employed, thecontroller 132 a can be in communication with and responsive to thecontroller 122 a of theIPG 120 to receive a signal that indicates whether an external field is present, based on data received from thefield sensor 122 c. - Further, if employed, the
controller 132 a can be in communication with and responsive to thefield sensor 132 b, and can be in communication with theswitch assembly 144. Based on the data received from thefield sensor 132 b, thecontroller 132 a can transmit a signal to thecontroller 122 a of theIPG 120, via the sensing/control conductor 152 d, which can indicate that an external field is present. In addition, based on the data received from thefield sensor 132 b, and thecontroller 122 a, thecontroller 132 a can transmit a signal to theswitch assembly 144 to electrically couple either thering electrode 140 or thetip electrode assembly 142 to thepacing conductor 150 to receive the therapy from theIPG 120. - If employed, the
field sensor 132 b can be responsive to an external field, such as that generated by a MRI scan, and can be capable of detecting multi-level field strengths and/or can be capable of discriminating between different field ranges. Thus, if desired, thefield sensor 132 b can be substantially similar to thefield sensor 122 c. - With reference to
FIG. 5 , a schematic illustration of theIPG 120 including thelead 124 is shown. As discussed, thelead 124 can include thering electrode 140 and thetip electrode 142 b. Thering electrode 140 can have a surface area that is greater than the surface area of thetip electrode 142 b, as discussed. Thering electrode 140 can further house theswitch assembly 144. Thepacing conductor 150 can carry a current from thepulse generator 122 b to theswitch assembly 144. - In one example, the
switch assembly 144 can be activated by theIPG 120. In this regard, based on only the receipt of the signal from thefield sensor 122 c, thecontroller 122 a can determine if the external field is present. If the external field is present, then thecontroller 122 a can output a signal to activate theswitch assembly 144 to switch from the first operational state to the second operational state. - In another example, the
switch assembly 144 can be activated by theIPG 120 and thefield sensor 132 b. In this regard, based on the receipt of the signal from thefield sensor 122 c and the signal from thefield sensor 132 b, thecontroller 122 a can determine if the external field is present. If the external field is present, then thecontroller 122 a can output a signal to activate theswitch assembly 144 to switch from the first operational state to the second operational state. Thecontroller 122 a can also determine if the signal from thefield sensor 122 c and the signal from thefield sensor 132 b are about equal. If the signal from thefield sensor 122 c and the signal from thefield sensor 132 b are not about equal, then thecontroller 122 a can output error data for theprogrammer 50 that can indicate that one of thefield sensor 122 c andfield sensor 132 b has failed. - In another example, the
switch assembly 144 can be activated by thecontrol system 122 of theIPG 120 and thefield control system 132 of thelead 124. In this regard, based on the signal from thefield sensor 122 c, thecontroller 122 a can output a signal for thecontroller 132 a that can indicate if an external field is present. If the external field is present, then thecontroller 122 a can output a signal to activate theswitch assembly 144 to switch from the first operational state to the second operational state where thetip electrode 142 and thering electrode 140 and selectively and briefly re-coupled to delivery therapy and then decoupled again from theIPG 120 so reduce heating of components or tissue. Thefield controller 132 a can receive the signal from thecontroller 122 a that indicates if the external field is present, and can receive the signal from thefield sensor 132 b that indicates if the external field is present. Thecontroller 132 a can determine if the signal from thefield sensor 122 c and the signal from thefield sensor 132 b are about equal. If the signal from thefield sensor 122 c and the signal from thefield sensor 132 b are not about equal, then thecontroller 132 a can output a signal for thecontroller 122 a such that thecontroller 122 a can output error data for theprogrammer 50. If, based on at least one of the signal from thefield sensor 122 c and thefield sensor 132 b, the external field is present, then thecontroller 132 a can also output a signal for thedrive circuit 144 c to activate theswitch assembly 144 to electrically decouple andre-couple tip electrode 142 and thering electrode 140 to theIPG 120 in the second operational state such that therapy can continue to be delivered during an MRI scan. - In yet another example, if the
lead 124 is not in the presence of an external field or in a normal operating state, then theswitch assembly 144 can be in contact with thetip contact 144 b, such that the current from theIPG 120 can flow to thetip electrode 142 b, via thetransmission coil 142 a, in the first operational state (i.e., no external field detected). If thelead 124 is in the presence of the external field, then theswitch assembly 144 can decouple thetip electrode 142 while allowing thering electrode 140 to remain connected for sensing purposes, in the second operational state. Thus, in the presence of an external field, thetip electrode 142 b can be electrically decoupled from thelead 124, which thereby reduces the effective length of thelead 124. In this regard, the amount of current or thermal energy induced in thelead 124 can depend upon a length of thelead 124. In the normal operating state, the length of thelead 124 can be illustrated as L1 (FIG. 5 ), while in the MRI operating state, the length L2 of thelead 124 can be illustrated as L2, since thetip electrode 142 b is electrically decoupled from thelead 124. Thus, by electrically decoupling thetip electrode 142 b from thelead 124, the overall conductive length of thelead 124 is reduced and the amount of current or thermal energy induced in thelead 124 can be greatly reduced, as well as reducing or eliminating heating of thetip electrode 142 b. Optionally, both thetip electrode 142 and thering electrode 140 can be decoupled from theIPG 120 to further reduce the electrical length of thelead 124. - With reference now to
FIG. 6 , a dataflow diagram illustrates anexemplary control system 198 that can be embedded within thecontroller 122 a of theIPG 120 and/or thecontroller 132 a of thelead 124. Various embodiments of thecontrol system 198 according to the present disclosure can include any number of sub-modules embedded within thecontroller 122 a of theIPG 120 and/or thecontroller 132 a of thelead 124. The sub-modules shown may be combined and/or further partitioned to similarly deliver a therapy to an anatomical tissue, such as theheart 42, in the presence of an external field, such as that encountered during a MRI scan. Inputs to the system can be received from thefield sensors IPG 120, and/or determined by other sub-modules within thecontroller 122 a of theIPG 120 and/or thecontroller 132 a of thelead 124. In various embodiments, thecontrol system 198 includes thecontroller 122 a of theIPG 120 that can implement anIPG control module 200 and thecontroller 132 a of thelead 124 that can implement alead control module 202. It should be noted that although theIPG control module 200 can be implemented by thecontroller 122 a of theIPG 120 and thelead control module 202 can be implemented by theoptional controller 132 a of thelead 124, both of theIPG control module 200 and thelead control module 202 can be implemented by thecontroller 122 a of theIPG 120, if desired. With continued reference toFIG. 6 , theIPG control module 200 can include an IPGfield control module 204 and apacing control module 206. - The IPG
field control module 204 can receive as input IPGfield sensor data 212. The IPGfield sensor data 212 can comprise a signal from thefield sensor 122 c and optionally, thefield sensor 132 b if employed, that can be used to determine whether or not an external field is present. Based on the IPGfield sensor data 212, the IPGfield control module 204 setsfield data 214 for thepacing control module 206 and thelead control module 202. Thefield data 214 can comprise data that indicates whether an external field, such as that generated by a MRI scan, is present. - The
pacing control module 206 can receive as input thefield data 214,heart rhythm data 216 andprogrammer data 218. Theheart rhythm data 216 can comprise the electrical activity of the anatomical tissue, such as theheart 42, as sensed by thering electrode 140. Theprogrammer data 218 can comprise data received from theprogrammer 50, such as a desired therapy to be output by theIPG 120 based on the presence of an external field, such as that generated by a MRI scan. Generally, theIPG 120 produces a pacing therapy at about 0.01 volts (V), however, this voltage value is programmable to achieve capture of the patient's heart muscle so that the pacing therapy can be effectively delivered. - Based on the
field data 214, theheart rhythm data 216 and theprogrammer data 218, thepacing control module 206outputs pacing data 220. Thepacing data 220 comprises a desired therapy for the anatomical tissue, such as to enter the second operational state where thetip electrode 142 andring electrode 140 are first decoupled from theIPG 120 and then selectively and briefly re-coupled to theIPG 120 for the delivery of therapy during the MRI scan. When the patient is no longer in the presence of the MRI field, then thepacing data 220 can re-couple thetip electrode 142 andring electrode 140 to resume normal pacing operation in the first operational state. - Based on the
field data 214, theheart rhythm data 216 and theprogrammer data 218, thepacing control module 206outputs pacing data 220. Thepacing data 220 comprises a desired therapy for the anatomical tissue, such as a desired electrical pulse to stimulate theheart 42. Thus, if based on theheart rhythm data 216, thepacing control module 206 determines that theheart 42 requires a pacing therapy, then, based on whether thepatient 40 is undergoing a MRI scan, as indicated by thefield data 214 and/or theprogrammer data 218, thepacing control module 206 outputs the appropriate level of therapy as pacingdata 220. Thepacing data 220 can instruct thepulse generator 122 c to generate the desired therapy for the anatomical tissue. - The
lead control module 202 can receive as input leadfield sensor data 224,heart rhythm data 216 andfield data 214. The leadfield sensor data 224 can be optional, and can comprise a signal from thefield sensor 132 b that can be used to determine whether or not an external field is present, such as that generated during a MRI scan. Based on the leadfield sensor data 224,heart rhythm data 216 andfield data 214, thelead control module 202 can output switchdata 226 and, optionally,error data 228. Theswitch data 226 can comprise a signal to theswitch assembly 144 to drive thedrive circuit 144 c to electrically decouple or re-couple either thering electrode 140 and/or thetip electrode assembly 142 to theIPG 120 based on whether an external field is present. If it is determined that an external field is present, based on the leadfield sensor data 224 and/orfield data 214, then theswitch data 226 can comprise a signal to electrically decouple thering electrode 140 and/or the ring electrode to theIPG 120 in the second operational state as described above. If it is determined that an external field is not present, then theswitch data 226 can comprise a signal to electrically re-couple thetip electrode assembly 142 and thering electrode 140 to the to theIPG 120 to return to the normal first operational state. - The
error data 228 can comprise a signal transmitted to theprogrammer 50 that there is an error associated with either thefield sensor 122 c of theIPG 120 or thefield sensor 132 b of thelead 124, if employed. In this regard, if thefield data 214 does not match the leadfield sensor data 224, thelead control module 202 can output theerror data 228 to indicate that there is a problem with either thefield sensor 122 c of theIPG 120 or thefield sensor 132 b of thelead 124. - With reference now to
FIG. 7 , a process flow diagram illustrates an exemplary method that can be performed by thecontrol system 198. Atblock 300, the method can obtain the IPGfield sensor data 212 from thefield sensor 122 c of theIPG 120. Then, atblock 302, the method can obtain the leadfield sensor data 224 from thefield sensor 132 b of thelead 124, if employed. Atdecision block 304, the method can determine if the leadfield sensor data 224 from thefield sensor 132 b is about equal to the IPGfield sensor data 212 from thefield sensor 122 c. If the IPGfield sensor data 212 and the leadfield sensor data 224 measured by therespective field sensors decision block 306. Otherwise, the method canoutput error data 228 atblock 308 and then go todecision block 306. - At
decision block 306, the method determines if the field present is greater than a threshold field. The threshold field can be equivalent to a field generated during a MRI procedure, and thus, can comprise a threshold value for a magnetic field or a threshold value for an electrical field. Further, the threshold field can be a value programmed into theIPG 120 by theprogrammer 50. If the field present is greater than the threshold field, then the method can go to block 310. Otherwise, the method can go to block 312. - At
block 312, the method re-couples thetip electrode 142 and ring electrode 130 to theIPG 120 if they had been previously decoupled inblock 310. Then, the method can loop to block 300. - At
block 310, the method can activate theswitch assembly 144 to electrically decouple theIPG 120 from thetip electrode assembly 142 andring electrode 140 such that thetip electrode assembly 142 cannot deliver the desired therapy to theheart 42 and thering electrode 140 is not sensing the heart. Then, atblock 316, the method can briefly re-couple thetip electrode 142 and thering electrode 140 to deliver therapy from the IPG to the patient. Then, atblock 318, the method can again decouple thetip electrode 142 and thering electrode 140 and loop to block 300 to again determine whether the patient remains in the external field; that is in one embodiment, having an MRI scan performed. - In a one preferred embodiment regard, the method can adjust decouple/re-couple timing so that the
tip electrode 142 and thering electrode 140 are decoupled approximately 95% of the time to reduce heating of the IPG components as well as the tissue adjacent to thetip electrode 142. - While specific examples have been described in the specification and illustrated in the drawings, it will be understood by those of ordinary skill in the art that various changes may be made and equivalents may be substituted for elements thereof without departing from the scope of the present disclosure as defined in the claims. Furthermore, the mixing and matching of features, elements and/or functions between various examples is expressly contemplated herein so that one of ordinary skill in the art would appreciate from this disclosure that features, elements and/or functions of one example may be incorporated into another example as appropriate, unless described otherwise, above. Moreover, many modifications may be made to adapt a particular situation or material to the teachings of the present disclosure without departing from the essential scope thereof. Therefore, it is intended that the present disclosure not be limited to the particular examples illustrated by the drawings and described in the specification as the best mode presently contemplated for carrying out this disclosure, but that the scope of the present disclosure will include any embodiments falling within the foregoing description and the appended claims.
Claims (19)
1. An implantable medical device operable to provide a therapy to an anatomical tissue comprising:
a lead having a body having at least one conductor to transmit the therapy through the body of the lead;
at least one tip electrode coupled to the body of the lead, the at least one tip electrode in electrical communication with the at least one conductor to deliver the therapy to a portion of the anatomical tissue in a first operational state;
a switch within the lead and in electrical communication with the at least one conductor and the at least one tip electrode to selectively deliver the therapy to the portion of the anatomical tissue in a second operational state; and
wherein the lead switches between the first operational state and the second operational state based on whether an external field is present.
2. The device of claim 1 , wherein the external field comprises a magnetic or electric field generated during a magnetic resonance imaging (MRI) scan.
3. The device of claim 2 , further comprising:
a control system operable to sense the presence of the external field; and
at least one ring electrode in electrical communication with the switch, the switch being in responsive to the control system to selectively decouple the at least one tip electrode and the at least one ring electrode in the second operational state and operable to briefly electrically re-couple the at least one ring electrode or the at least one tip electrode to delivery therapy in the presence of the electric field generated during a magnetic resonance imaging (MRI) scan.
4. The device of claim 3 , further comprising:
a therapy device implanted in a portion of the anatomical tissue and operable to generate the therapy for the anatomical tissue, the therapy device in electrical communication with the at least one conductor to deliver the therapy to the at least one tip electrode and for receiving sensing from the at least one ring electrode depending upon whether the lead is in the first operational state or the second operational state.
5. The device of claim 4 , wherein the therapy device is an implantable pulse generator (IPG) and the lead is an IPG stimulation lead.
6. The device of claim 4 , wherein the lead further comprises a sensing conductor in electrical communication with the at least one ring electrode to receive a signal indicative of electrical activity of the anatomical tissue and in electrical communication with the therapy device to conduct the signal to the therapy device.
7. The device of claim 6 , wherein each of the at least one tip electrode further comprises:
a transmission member in electrical communication with the switch and operable to receive the therapy from the pacing conductor; and
an electrode in electrical communication with the transmission member to conduct the therapy to the portion of the anatomical tissue adjacent to the electrode.
8. The device of claim 7 , wherein the control system further comprises:
at least one sensor responsive to the external field to generate a signal; and
at least one controller in communication with the at least one sensor to receive the signal and in electrical communication with the switch to activate the switch such that the switch electrically couples the at least one ring electrode and the at least one tip electrode to the therapy device based on the signal from the at least one sensor.
9. The device of claim 4 , wherein the switch couples the at least one tip electrode and the at least one ring electrode approximately 5% of the time during second operational state to continue to deliver the therapy in the presence of the electric field generated during a magnetic resonance imaging (MRI) scan.
10. The device of claim 4 , further comprising:
a programmer operable to program the therapy device to deliver the therapy through the lead.
11. The device of claim 8 , wherein the at least one sensor further comprises:
a first sensor disposed in the therapy device and responsive to the external field to generate a first signal;
a second sensor disposed in the lead and responsive to the external field to generate a second signal; and
wherein the at least one controller receives the first signal and second signal and based on the first signal and second signal determines if the external field is present and outputs error data if the first signal is not about equal to the second signal.
12. The device of claim 11 , wherein the at least one controller further comprises:
a first controller disposed in the therapy device and in communication with at least the first sensor to receive the first signal and to generate the therapy; and
a second controller disposed in the lead and in communication with the second sensor to receive the second signal and in communication the first controller to receive the first signal, the second controller operable to activate the switch based on the first signal, the second signal or a combination thereof.
13. The device of claim 1 , wherein the at least one ring electrode has a surface area that is about equal to or greater than a surface area of the at least one tip electrode.
14. A method of controlling a cardiac lead implanted in an anatomical structure during the presence of an external field comprising:
providing a lead having at least one conductor passing through the lead, at least one first electrode operable to be in electrical communication with the at least one conductor to deliver a therapy to a portion of an anatomical tissue associated with the anatomical structure;
determining whether the external field is present;
electrically coupling the at least one first electrode with the at least one conductor to deliver therapy if the external field is not present; and
electrically decoupling the at least one first electrode with the at least one conductor if the external field is present and selectively re-coupling the at least one first electrode with the at least one conductor to deliver the therapy before again decoupling the at least one first electrode with the at least one conductor.
15. The method of claim 14 , further comprising:
providing a therapy device that generates the therapy;
providing a programmer operable to program the therapy device to generate the therapy; and
programming the therapy device to generate the therapy.
16. The method of claim 15 , wherein determining whether the external field is present further comprises:
sensing the external field by a sensor disposed in the therapy device;
sensing the external field by a sensor disposed in the lead;
receiving a signal from the programmer that indicates that the external field is present; or
combinations thereof.
18. The method of claim 14 , wherein electrically decoupling and selectively re-coupling the at least one first electrode further comprises re-coupling the at least one first electrode approximately 5% of the time during which the external field is present.
19. An implantable medical device operable to provide a therapy to an anatomical tissue comprising:
a therapy device implanted in a portion of an anatomical structure and operable to generate the therapy for the anatomical tissue;
a lead having a proximal end in electrical communication with the therapy device to receive the therapy, a distal end and a body having at least one conductor to carry the therapy through the body of the lead;
at least one tip electrode coupled to the distal end of the lead that is operable to deliver the therapy to a first portion of the anatomical tissue;
at least one ring electrode coupled to the lead and operable to deliver sensing information from the anatomical tissue;
a switch operable to electrically decouple the at least one conductor and the at least one tip electrode from the therapy device; and
at least one control system operable to activate the switch to electrically couple the at least one ring electrode and the at least one tip electrode in a first operational state or to selectively electrically decouple and re-couple the at least one ring electrode and the at least one tip electrode in a second operational state based on the presence of an external field.
20. The device of claim 19 , wherein the external field comprises a magnetic or electric field generated during a magnetic resonance imaging (MRI) scan.
Priority Applications (3)
Application Number | Priority Date | Filing Date | Title |
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US12/363,321 US20100198311A1 (en) | 2009-01-30 | 2009-01-30 | System and method for cardiac lead switching |
EP10702960A EP2401032A1 (en) | 2009-01-30 | 2010-01-28 | System and method for cardiac lead switching |
PCT/US2010/022345 WO2010088341A1 (en) | 2009-01-30 | 2010-01-28 | System and method for cardiac lead switching |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
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US12/363,321 US20100198311A1 (en) | 2009-01-30 | 2009-01-30 | System and method for cardiac lead switching |
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US20100198311A1 true US20100198311A1 (en) | 2010-08-05 |
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US12/363,321 Abandoned US20100198311A1 (en) | 2009-01-30 | 2009-01-30 | System and method for cardiac lead switching |
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US (1) | US20100198311A1 (en) |
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EP2401032A1 (en) | 2012-01-04 |
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